Pancreatic cancer is a highly aggressive malignancy with a poor prognosis, and surgical resection remains the only potentially curative treatment. However, since most patients are diagnosed at a locally advanced or metastatic stage, the feasibility of upfront surgery is limited. In recent years, neoadjuvant and conversion therapy have emerged as crucial strategies for borderline resectable and locally advanced pancreatic cancer, aiming to increase the R₀ resection rate and improve survival outcomes. Studies have shown that FOLFIRINOX and gemcitabine plus nab-paclitaxel are commonly used neoadjuvant chemotherapy regimens, with the former being more suitable for patients with good performance status, while the latter is better tolerated across a broader patient population due to its lower toxicity. Additionally, radiotherapy, such as stereotactic body radiotherapy (SBRT), can enhance local tumor control, increase tumor cell eradication, and minimize damage to normal tissues, thereby optimizing overall treatment efficacy. Despite the significant advantages of this approach, challenges remain, including the management of toxic side effects and the optimization of treatment protocols. Future research will focus on personalized precision medicine, integrating genomic sequencing and radiomics to refine neoadjuvant/conversion therapy strategies and exploring the combination of chemotherapy, radiotherapy, immunotherapy, and targeted therapy to improve long-term survival in pancreatic cancer patients. This paper summarizes recent advancements in neoadjuvant/conversion therapy combined with radiotherapy for pancreatic cancer and discusses its potential role in modulating tumor biology and optimizing treatment strategies.